T. Michael Bolger Standing Ovation Award Nomination Form

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The MCW Student Assembly is accepting nominations for the T. Michael Bolger Standing Ovation Awards. Each year the Student Assembly recognizes students, faculty and staff who have made outstanding contributions to student life at MCW. You are welcome to nominate anyone whom you feel has gone above and beyond to benefit MCW students. The nominees and winners of the award will be honored at the T. Michael Bolger Standing Ovation Awards Ceremony in April.

To nominate someone, please fill out this form in its entirety. Nominations will be accepted until MARCH 17TH.

Your name, department, and mailing address *

Nominee's full name and department (if applicable) *

Nominee's Status *

First year medical student

Second year medical student

Third year medical student

Fourth year medical student

Graduate Student

Faculty

Staff

Resident Physician

Attending Physician

Other:

In 150-200 words, please describe the nominee’s outstanding contributions which distinguish them as an ideal candidate for the Standing Ovation Awards. Additionally, please list 3-5 SPECIFIC examples of how the nominee has gone above and beyond their required roles to enhance student life at MCW. (Do NOT include activities related to MCW Student Assembly) *

Additional comments - why do you believe this person should be chosen to receive the award? *

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